By Mohab Hanna, MD, Child and Adolescent Psychiatrist
The decision to go on psychiatric medication can be a challenge for many, especially as it relates to children and teenagers who are struggling with a variety of psychiatric illnesses. One of the things that I have noticed over the years is the high level of frustration and disappointment that occurs when the prescribed psychiatric medication does not help. At times, there can even be some anger and resentment at the process. I have had many patients including kids and teens tell me that “I feel like I am an experiment”. “I hate having to try so many different medications to find one that helps me to feel better.” These are all legitimate responses to the situation. It can be extremely difficult and frustrating to know that you are seeking help and at the same time you are not getting better. Demoralization makes sense in that situation. At the same time, it is important to understand why this scenario is much more common than most people realize.
As a practice that specializes in psychopharmacology (prescribing psychiatric medications) in children, teenagers, and adults we do many consultations with patients who come in to see us already on a variety of prescribed psychiatric medications from an outside provider. One of the most common reasons we see in our psychiatric practice for lack of effectiveness is that the diagnosis is not accurate. The most common scenario is when someone is diagnosed with ADHD and is being treated with ADHD medication, but the issue is one of an anxiety disorder. It is very easy to confuse the two diagnoses since they can look and come across the same. This is true not just in children but in adults as well. Lack of focus or difficulty paying attention can be caused by anxiety and depression or even Bipolar Disorder. An inaccurate diagnosis will naturally lead to a prescribed psychiatric medication not working and potentially making things even worse. This scenario can also occur if someone has an underlying Bipolar Disorder that has never manifested any mania. For those patients who have Bipolar Disorder who take an anti-depressant, their moods will never truly regulate on just an anti-depressant. As a matter of fact, in that scenario, the antidepressant (such as Prozac, Zoloft or Cymbalta) will dysregulate the mood and make things much worse.
Another common reason for the lack of effectiveness of the prescribed medication is negative side effects. Experiencing certain side effects will potentially negate any positive response to the medication. A common example is with the Selective Serotonin Reuptake Inhibitors (SSRIS- Fluoxetine (Prozac), Sertraline (Zoloft), Fluvoxamine (Luvox), Paroxetine (Paxil), Citalopram (Celexa), Escitalopram (Lexapro). The SSRIs are frequently used to treat all major Anxiety Disorders as well as Major Depressive Disorders even in children and teenagers. SSRIs can cause something called activation if they are started on too high of a dose or if someone is extremely sensitive. Activation can also occur when a dosage is increased. Activation is a bad form of physical anxiety that feels awful and is in fact a worsening of anxiety that will also make someone feel more depressed, angry, irritable, agitated, and more nervous. If this occurs it will negate any potential benefit from the SSRI medication in the treatment of anxiety or depression.
The third reason sometimes medications don’t work is that there is no psychiatric illness to treat. Psychiatric medications are prescribed to address underlying chemical biological illnesses only. If the issue and the struggle is related to life circumstances or other emotional challenges that have nothing to do with an underlying illness then there is no legitimate reason to even take a prescribed medication. The solution in that case is counseling and therapy vs psychiatric medications
